TY - JOUR
T1 - Effect of general anesthesia and orthopedic surgery on serum tryptase
AU - Garvey, Lene H
AU - Bech, Birgitte Louise
AU - Mosbech, Holger
AU - Krøigaard, Mogens
AU - Belhage, Bo
AU - Husum, Bent
AU - Poulsen, Lars K
PY - 2010/5/1
Y1 - 2010/5/1
N2 - BACKGROUND: Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis. METHODS: The study included 120 patients (median age, 54 yr; range, 19-94 yr) undergoing elective orthopedic surgery in general anesthesia. Exclusion criteria were allergic reactions during this or previous anesthesia, hematologic disease, or high-dose corticosteroid treatment. Blood samples for tryptase analysis (ImmunoCAP®; Phadia, Uppsala, Sweden) were drawn shortly before anesthesia and after anesthesia and surgery. RESULTS: Median duration of anesthesia was 105 min (range, 44-263 min). Median interval between blood samples was 139 min (range, 39-370 min). Mean tryptase before surgery was 5.01 μg/l, with a mean decrease of 0.55 μg/l (P < 0.0001; 95% CI, 0.3-0.8) postoperatively. All patients received intravenous fluid (median value 750 ml; range, 200-2000 ml) perioperatively. There was no significant effect of gender, age, American Society of Anesthesiologist's physical status classification, or self-reported allergy on serum tryptase. CONCLUSIONS: Serum tryptase shows small intraindividual variation in the absence of anaphylaxis. A small decrease was observed postoperatively, likely due to dilution by intravenous fluid. On suspected anaphylaxis during anesthesia, tryptase values, even within the normal reference interval, should, when possible, be compared with the patient's own basal level taken more than 24 h after the reaction.
AB - BACKGROUND: Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis. METHODS: The study included 120 patients (median age, 54 yr; range, 19-94 yr) undergoing elective orthopedic surgery in general anesthesia. Exclusion criteria were allergic reactions during this or previous anesthesia, hematologic disease, or high-dose corticosteroid treatment. Blood samples for tryptase analysis (ImmunoCAP®; Phadia, Uppsala, Sweden) were drawn shortly before anesthesia and after anesthesia and surgery. RESULTS: Median duration of anesthesia was 105 min (range, 44-263 min). Median interval between blood samples was 139 min (range, 39-370 min). Mean tryptase before surgery was 5.01 μg/l, with a mean decrease of 0.55 μg/l (P < 0.0001; 95% CI, 0.3-0.8) postoperatively. All patients received intravenous fluid (median value 750 ml; range, 200-2000 ml) perioperatively. There was no significant effect of gender, age, American Society of Anesthesiologist's physical status classification, or self-reported allergy on serum tryptase. CONCLUSIONS: Serum tryptase shows small intraindividual variation in the absence of anaphylaxis. A small decrease was observed postoperatively, likely due to dilution by intravenous fluid. On suspected anaphylaxis during anesthesia, tryptase values, even within the normal reference interval, should, when possible, be compared with the patient's own basal level taken more than 24 h after the reaction.
U2 - 10.1097/aln.0b013e3181d40383
DO - 10.1097/aln.0b013e3181d40383
M3 - Journal article
SN - 0003-3022
VL - 112
SP - 1184
EP - 1189
JO - Anesthesiology
JF - Anesthesiology
IS - 5
ER -